OMB Approved No.

2900-0406
Respondent Burden: 5 minutes

VERIFICATION OF VA BENEFITS
PRIVACY ACT NOTICE: The VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 5, Code of
Federal Regulations 1.526 for routine uses (i.e., information concerning a veteran’s indebtedness to the United States by virtue of a person’s participation in a benefits program administered by
VA may be disclosed to any third party, except consumer reporting agencies) as identified in the VA system of records, 55VA26, Loan Guaranty Home, Condominium and Manufactured
Home Loan Applicant Records, Specially Adapted Housing Applicant Records and Vendee Loan Applicant Records - VA, and published in the Federal Register. Your obligation to respond is
required to obtain or retain benefits. Giving us your SSN account information is voluntary. Refusal to provide your SSN by itself will not result in the denial of benefits. The VA will not deny
an individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by a Federal Statute of law in effect prior to January 1, 1975, and still in effect.

TO: NAME AND ADDRESS OF LENDER (Complete mailing address including ZIP Code) INSTRUCTIONS TO LENDER
Complete this form ONLY if the

..
veteran/applicant:

.. is receiving VA disability payments; or

has received VA disability payments; or
would receive VA disability payments but
for receipt of retired pay; or
is surviving spouse of a veteran who died on

. active duty or as a result of a

service-connected disability
has filed a claim for VA disability benefits prior
to discharge from active duty service

Complete Items 1 through 10. Send the completed form to

the appropriate VA Regional Loan Center where it will be
processed and returned to the Lender. The completed form
must be retained as part of the lender’s loan origination
package.
1. NAME OF VETERAN (First, middle, last) 2. CURRENT ADDRESS OF VETERAN

3. DATE OF BIRTH

4. VA CLAIM FOLDER NUMBER (C-File No., if known) 5. SOCIAL SECURITY NUMBER 6. SERVICE NUMBER (If different from Social Security Number)

7. I HEREBY CERTIFY THAT I
the information listed below.
8. I HEREBY CERTIFY THAT I HAVE
(I am presently still on active duty.)
9. SIGNATURE OF VETERAN
DO DO NOT have a VA benefit-related indebtedness to my knowledge. I authorize VA to furnish
HAVE NOT filed a claim for VA disability benefits prior to discharge from active duty service
10. DATE SIGNED

FOR VA USE ONLY

The above named veteran does not have a VA benefit-related indebtedness
The veteran has the following VA benefit-related indebtedness
VA BENEFIT-RELATED INDEBTEDNESS (If any)
TYPE OF DEBT(S) AMOUNT OF DEBT(S)

TERM OF REPAYMENT PLAN (If any)

Veteran is exempt from funding fee due to receipt of service-connected disability compensation of $ monthly. (Unless checked,
the funding fee receipt must be remitted to VA with VA Form 26-1820, Report and Certification of Loan Disbursement)

Veteran is exempt from funding fee due to entitlement to VA compensation benefits upon discharge from service.

Veteran is not exempt from funding fee due to receipt of nonservice-connected pension of $ monthly. LOAN APPLICATION WILL
REQUIRE PRIOR APPROVAL PROCESSING BY VA.

Veteran has been rated incompetent by VA. LOAN APPLICATION WILL REQUIRE PRIOR APPROVAL PROCESSING BY VA.
Insufficient information. VA cannot identify the veteran with the information given. Please furnish more complete information, or a copy of a DD
Form 214 or discharge papers. If on active duty, furnish a statement of service written on official government letterhead, signed by the adjutant,
personnel officer, or commanding officer. The statement should include name, birth date, service number, entry date and time lost.

SIGNATURE OF AUTHORIZED AGENT DATE SIGNED

Respondent Burden: We need this information to determine, establish, or verify your eligibility for VA Loan Guaranty Benefits and to determine if you are exempt from paying
the VA Funding Fee. Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 5 minutes to review the instructions, find
the information, and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to
respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at
www.whitehouse.gov/library/omb/OMBINVC.html#VA. If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.
VA FORM
NOV 2005 26-8937 SUPERSEDES VA FORM 26-8937, AUG 2004,
WHICH WILL NOT BE USED.